Cul-de-sac aspiration for diagnostic cytologic study

Soluble Epidermal Growth Factor Receptor (SEG-FR) and Cancer Antigen 125 (CA125) as Screening and Diagnostic Tests for Epithelial Ovarian Cancer

Epithelial ovarian cancer (EOC) is the leading cause of death among all gynecologic cancers in the United States. Because women who are diagnosed with early stage disease have a better prognosis than women diagnosed with late stage disease, early detection represents a potentially practical approach to reduce the mortality associated with EOC. Unfortunately, no single screening test has proven to be effective for this purpose, and a valid and feasible screening program to detect early stage EOC in the general population has not yet been devised. Consequently, research has focused on coupling two or more screening modalities to improve program validity and feasibility. Serum cancer antigen 125 (CA125) and a soluble isoform of the epidermal growth factor receptor (p110 sEGFR) have been studied individually as biomarkers of ovarian cancer. In this study, we compare serum CA125 levels and sEGFR concentrations in women with EOC to women with benign gynecologic conditions of ovarian and non-ovarian origin. We show that serum sEGFR concentrations are lower in patients with EOC than in women with benign gynecologic conditions, whereas serum CA125 levels are higher in patients to EOC compared with women with benign gynecologic conditions. These data also reveal that age and serum sEGFR concentrations modify the association between CA125 levels and EOC versus benign gynecologic disease. Hence, age- and sEGFR-dependent CA125 cutoff thresholds improve the ability of CA125 to discern EOC patients from women with benign ovarian tumors and non-ovarian gynecologic conditions. Our analyses show that parallel testing with fixed sEGFR and CA125 cutoff thresholds optimizes sensitivity to detect EOC, whereas serial testing with age- and sEGFR-dependent CA125 cutoff thresholds optimizes test specificity, and overall accuracy to discern patients with EOC from women with benign ovarian and non-ovarian gynecologic conditions. The combined use of serologic sEGFR and CA125, thus, has improved utility for screening and diagnosing EOC, which may increase the positive predictive value of a multimodal screening program that incorporates these biomarkers to detect and subsequently differentiate benign from malignant ovarian tumors.

Screening for ovarian cancer: a review

A review of the literature was done to assess the evidence for ovarian cancer screening, and the effectiveness of the different methods of screening. There is not yet sufficient evidence that an ovarian cancer screening programme would be cost-effective, given the current range of available tests. The high rate of surgical intervention makes the choice of screening test extremely important. No single test is able to provide a positive predictive value of greater than 10%. For women over 30 years of age with a strong family history of ovarian cancer (two or more first-degree relatives) there is an increased risk, potentially as high as one in two, of developing a carcinoma. These women should be offered counselling and annual serum CA 125 and ultrasonography as part of a coordinated research programme, which includes genetic studies.

Evolution of screening for epithelial ovarian carcinoma: the quest for early diagnosis

Epithelial ovarian carcinoma remains the most fatal of gynecologic malignancies, causing approximately 13,300 deaths annually. This high mortality rate is due to the presence of advanced stage disease at time of diagnosis. Symptoms early in the course of the disease are frequently nonspecific and go unrecognized by both the patient and the physician. The cause-specific mortality may decrease if a sufficiently sensitive screening modality can be developed to allow early diagnosis and curative therapy. The ideal screening tests or algorithm utilizing several tests must have sufficient specificity to minimize false positives, which contribute to patient anxiety and inefficient use of health care dollars. The development and refinement of the various methodologies used in screening of epithelial ovarian carcinoma will be the subject of this review.

Screening for ovarian cancer: the role of noninvasive imaging techniques

In spite of diagnostic and therapeutic improvements the Surveillance Epidemiology and End Results Program data suggest that the overall cure rate for patients with ovarian cancer is 39%. Because of the dramatic difference in cure between patients with local disease (80% to 90%) and those with distant disease (15% to 25%), screening to find early ovarian cancer or its precursors is desirable. Transvaginal ultrasonography is the most efficient, accurate, and least expensive of the imaging modalities (transabdominal ultrasonography, computed tomography, magnetic resonance imaging, radioimmunoscintigraphy) for this purpose. To date, 10,000 women have been screened in three large programs; 11 cancers were detected (10 stage I, one occult stage IIIB) and all have apparently been cured. Doppler flow imaging and morphology index values improve the accuracy of transvaginal ultrasonography. A cost analysis suggests that screening costs are not yet less than treatment costs if there is to be universal screening of 27 million women at risk in the United States. However, for a population with a lifetime risk for ovarian cancer of 1%, screening will save five lives per 2000 patients screened.

Ovarian cancer screening. The search for cost-effective methods

The search goes on for an effective screening test for ovarian cancer. This deadly disease has eluded attempts at early detection with the currently available methods. Dr Williams examines the research regarding various screening methods and suggests areas of promise for future study.

Hereditary ovarian cancer. Heterogeneity in age at diagnosis

An unknown fraction of the ovarian cancer burden occurs in women with a family history indicative of a putative autosomal dominantly inherited cancer susceptibility syndrome. The results from a five-generation, extended, hereditary breast-ovarian cancer kindred are described 10 years after it was initially ascertained. Significantly more cancers were observed in high-risk family members during this decade than were expected (P less than 0.001). The age of ovarian cancer diagnosis was studied in additional ovarian cancer-prone families of three types: site-specific ovarian cancer syndrome, the breast-ovarian cancer syndrome, and Lynch syndrome II. The age of onset in each of the three sets was significantly (P less than 0.001) earlier than the general population mean of 59, and there were significant differences in the age of onset (P = 0.050) among these three cohorts. Ovarian cancer histology was similar to that of patients with negative family histories. There may be clinically significant heterogeneity in the age at diagnosis of ovarian cancer among these ovarian cancer-prone syndromes. This has important implications for understanding its natural history and targeting surveillance-management strategies.

Transvaginal sonography as a screening method for ovarian cancer. A report of the first 1000 cases screened

From November 1987 to April 1989, 1000 women 40 years or older underwent screening vaginal sonography at the University of Kentucky Medical Center (Lexington, KY). Patients included in this investigation were all asymptomatic and had no known pelvic abnormalities. Each ovary was measured in three planes and ovarian volume was calculated using the prolate ellipsoid formula. The upper limit of normal for ovarian volume was 18 cm3 in premenopausal women and 8 cm3 in postmenopausal women. In patients with normal scans, mean ovarian volumes decreased from 6.8 cm3 to 3.0 cm3 with menopause. Thirty-one patients (3.1%) had abnormal vaginal sonograms and 24 underwent exploratory laparotomy. All patients undergoing surgery had ovarian or fallopian tube tumors with dimensions identical to those predicted by ultrasound. Histologic diagnoses of these tumors included the following: adenocarcinoma, one, serous cystadenoma, eight; endometrioma, six; and cystic teratomas, two. Vaginal sonography was performed easily and without complications, and was well accepted by patients. All patients with normal sonograms have been rescreened annually and none have subsequently developed ovarian cancer. Further clinical trials to determine the efficacy of vaginal sonography as a screening method for ovarian cancer are indicated.

Age and peritoneal fluid cellular distribution in women 20-40 years of age

Cytologic aspiration specimens of peritoneal fluid revealed that mesothelial cell proportions were significantly reduced 19.2% in women between 26 and 35 years of age. Possibly, mesothelial cell renewal was decreased in women of the older age groups.

Ovarian cytology. An application of cytology in an attempt at the early detection of ovarian carcinoma

The possibility of detecting pre-clinical ovarian carcinoma by ovarian cytology taken at the time of laparotomy has been studied in 472 patients. Malignant cells have been recovered from ovarian carcinomas but never from macroscopically normal ovaries. It is suggested that this simple, inexpensive technique of sampling cells from the ovarian surface should be continued to be practised on all occasions at which ovaries present such as at laparotomy or at laparoscopy, as with further experience this technique may prove to be of help in the early diagnosis of ovarian carcinoma.